Pomeranian 6 years 6 months old dental cleaning. I'm worried about anesthesia.

[Wtps]

My 6 year 6 month Pomeranian went in for his yearly shots. We finally got a good look in his mouth and found that he has 3 loose teeth. One tooth fell out 2 weeks after his yearly visit so back to the vet on Thursday was told no sign of abscess or infection. I gave him bones used enzymatic toothpaste when HE would allow me yet it didn't work out and I feel terribly about this. He was supposed to go in for a dental last year but I put it off b/c my friends said I was insane to put a dog under anesthesia for a cleaning and I was scared to put him under and didn't know what I know now. Moderate build up on some teeth and he needs a dental. I'm having a consultation w/the vet on Monday and hopefully will have him done next week. He banged his snout a few weeks ago while chasing a cat would that cause the teeth to become loose? Now that's the background here's the issue. I'M DEATHLY AFRAID of him going under the anesthesia. I know tooth loss and decay causes worse problems but I've been crying myself sick and have been ultra nervous about this. I thought I was doing the right thing by giving him bones and brushing with the enzymatic toothpaste but I just couldn't reach all the areas.
I'm afraid he will die at the vets. It's terrible I've lost sleep and can barely eat. I just feel my best friend is going to be lost. Can you please tell me any precautions I can ask the vet to do? I heard certain small breeds don't do well under injection anesthesia and should be given as gas, but on the website it says they pre-medicate with an injection, then IV medication to lose consciousness then gas to keep them under. I heard bad stories about the injections and I'm fearful. This is an animal hospital that is AAHA certified. This isn't a vet dentistry office. Do I need the specialist or am I OK at this vet(this vet also performed my dogs neutering using Isoflurane anesthesia. Does isoflurane involve the injections too or is it just gas? Could his heart and kidneys be damaged?

[Jennifer Mathis, D.V.M.]

Please clarify.  Did your vet say your dog didn't need xrays of the mouth at all? or not again after the procedure until next dental (6-12 months depending on pet/mouth)?

ie were xrays ever taken?

If not, there is likely still a problem present in your baby's mouth.

I'll wait for your reply to let me know what xrays were taken/when to clarify my answer as there are lots of reason xrays may or may not be needed at different times depending on what is happening in a pet's mouth.

It is needed at least at the first procedure, though - -MINIMALLY.
Dr. Jen

[Jennifer Mathis, D.V.M.]

Hopefully Doxirobe works, but if several pockets are present, they usually lead to teeth loss.  Again it's much better off without a tooth than a painful tooth.  Dogs and cats WITHOUT ANY teeth can still eat hard food.  If no teeth are present, it's better to feed soft food or moistened dry food as having more moisture is better for the body.  Soft food tends to have more fat which is not good for the waist/joints. Soft food will damage teeth faster, so hard is better when teeth remain.

20% of small dogs get sore at the injection site with the porphormonas vaccine.  My own little dog (12 lbs) with tooth loss (fractured and damaged and finally removed) was sore, but improved within 3 days, and was less sore with the booster given 4 wks later.  Given the pockets you've reported it may not be beneficial to give the vaccine as it helps prevent problems that may already be present and the vaccine is not 100%.  It becomes a personal choice.

All dogs have essentially the same number of teeth (unless they didn't come in from birth).  IT IS BETTER OFF WITHOUT A TOOTH THAN A PAINFUL TOOTH. You cannot change the past.  They can still eat hard food.  They are no longer painful without the tooth -- ie don't worry about the # of teeth extracted - only very few teeth are important for function, but function is still fine without ANY teeth.  A toothless dog has a better quality of life than a dog with few teeth with pockets and recurring pain.

[Jennifer Mathis, D.V.M.]

Don't beat yourself up.  I think I stated I don't brush my dog's teeth.  I do do other comprehensive preventatives though as well as regular anesthetic dental cleanings.  I've even had to do extractions on my own dog - better that have body problems/pain.

If you mean baby or deciduous teeth by "milk" teeth, it's a common issue that is unrelated to what you are likely seeing now.
The warning of bad teeth to come is the size of the pet. 85% of all pets have dental disease by age 3.  It higher % and earlier in pets under 25#.  ie any pet under 25# will have dental problems - it is a known fact that is often under emphasized by many veterinarians.

[Jennifer Mathis, D.V.M.]

The second article by Fraser Hale about dental truths states that once there's a problem tooth - almost always the only options are extraction or root canal.  They can actually eat hard food well without any teeth, if the teeth are removed correctly and no retained pieces nor hiding teeth remain.  A dog has 42 teeth and really only 10 could do the same function.  Often it is better to loose a tooth than have that unimportant tooth continue decay and damage an important tooth.  If what I think is happening in your baby's mouth is really going on (xrays under anesthesia will tell), it is best to extract teeth and not try to save them.  All too often a borderline tooth is much worse than we think and damages other teeth and the body. Again, remove any damaged tooth.

Bio glass - I think you are referring to a product called Consil.  If consil gets placed in a socket where much bacteria are or if the socket has so much damage it communicates with the sinuses, problems can result.  It's not so much the bacteria as the body's reaction causing tissue irritation.  ie don't over use it.  There are non specialists that have this material.  If it's a case of the remaining bone of the lower jaw may fracture once the damaged tooth has been removed, consil or the like is a good choice.  You  may need to see a specialist on that one, or your DVM may have it.  Please let your veterinarian make the choice.  Consil, when it works, improves the jaw bone by about 10% over nothing but the blood clot - ie it is often not needed.  If you really want to have something there, see a specialist that uses an osteoallograft or OraMend -- the new much safer products than the bio glass that don't cause the irritation that sterile glass shards can cause.

ie let your veterinarian make the choices for the best health of your pet.  I do use the OraMend graft and have Consil, but rarely is it needed - ie your baby will likely have the same outcome either way unless the jaw is destabilized.

Best of luck!

[Arnold L Goldman, D.V.M.]

Hi,

Propofol is among the safest induction agents we have. The use of isoflurane requires inserting a plastic or silicone tube into the airway ( as afety factor) and the ability to do that requires the rapid ability to control the head and airway. Induction of anesthesia is most frequently accomplished with an injectable induction agent like propofol. The propofol/isoflurane combination is among the safest. You need not second guess your doctor's jusdgement about the drugs used. Presence of an iv catheter, blood pressure monitoring, airway intubation, warmth provision and other factors are in my view far more critical in the average patient than the actual drugs used to induce anesthesia.

Please let us know how your little guy does.

Sincerely,

Dr. G

[Jennifer Mathis, D.V.M.]

Using an iv or im drug prior to isoflorane is the best medicine.  I would not worry about the propofol - that's good medicine to make it less stressful your little boy's procedure.

It's okay that there's no fibrillator.  At the university emergency clinic, they once commented that it was almost an unnecessary piece of equipment it rarely changes the outcome even when used promptly properly.

I hope valium is not the only pain med they're using.  I would recommend a combination pain protocol starting with an NSAID prior to the procedure (assuming he'll stay hydrated and warmed with IV fluids during the dentistry), a nerve block (think novacaine from your dentist, but slightly different) during the procedure, and ideally morphine during/just post op assuming teeth need extraction.  If bloodwork is good and fluids were given during the procedure, an NSAID should go home with you.

The porphormonas vaccine can be good, but needs a clean slate to be administered and may have a local swelling at injection site that is less so on the booster 1 month later.  If many teeth are removed, it may not be worth doing until the mouth has healed, but it is a beneficial vaccine.  A dental diet and oravet are good choices.  I use CET veggie dents in addition to those two home care options for my little dog.  A combination approach is best, but nothing will prevent the need for a cleaning in the next 6-12 months.  You will delay the buildup with your home care making the problems not as bad for future - ie less systemic damage over time.

Good job for taking care of your little guy!
Dr. Jen